In today’s rapidly evolving healthcare landscape, integrating artificial intelligence into revenue management processes is essential. Leveraging AI can streamline claims processing, reduce denials, and enhance revenue outcomes.

According to Global MarketInsights the projected market value for healthcare revenue cycle will be over $275 billion in 2028. This staggering figure shows how vital revenue cycle management is for healthcare providers.

Best practices in revenue cycle management protect profitability and operational efficiency at the back end of an organization. Consistent revenue cycles mean more financial stability for the organization. Many healthcare providers have difficulty improving revenue cycles. Look at the ways to improve revenue management for healthcare providers.

How to improve revenue cycle management in healthcare

 

Investing in staffing

The right team is essential for every aspect of medical service provision, from collecting payments from patients to ensuring that revenue is managed properly. Revenue cycle management may suffer if your staff isn’t properly trained to use the tools and methodologies. Investing in your staff could mean:

• The right level of guidance and training
• Continually educating staff on communication with payers and patient
• Training on billing or data entry

Collaboration is another important aspect of staffing. Assuring a consistent link between departments and roles is important. You may have a person handling billing and coding, while another is handling denials. The denial will be reduced faster if these two people are connected.

Regularly update processes

Keeping track of your internal processes is crucial to improving the revenue cycle. Revenue issues are known to start small, but become more complex the longer they’re ignored. If you notice early on that your denial rates are high, it is important to update processes as soon as possible in order to reduce them. It is inevitable that claims will be denied. CMS data show that approximately 18% are initially denied. Regular audits of denials can help clarify the root causes and prevent them.

Utilize advanced management practices by incorporating specialized software solutions tailored for distinct industry needs. This approach guarantees an improved revenue cycle model akin to healthcare innovations. For industries like alarm companies, integrating efficient revenue systems bolstered by business management software for alarm companies can optimize financial operations and stability.

Use revenue data analytics to keep a clear picture of your revenue management processes. Analyze financial data to monitor payment delays, look at performance indicators and determine how many denials occur. This data will help you identify areas that need attention and implement changes to maintain revenue cycles.

Offer patients multiple ways to pay

Payments will be more efficient if patients can pay bills easily. Assure patients that they have multiple payment options. This will improve patient experience and revenue management. In a study conducted in 2021, it was found that more than half of the patients prefer to use contactless payment methods to pay for their bills, as well as online bill payments and mobile wallets. A survey conducted in 2021 revealed that almost half of respondents stated that paying medical bills is harder than any other type of bill.

Verify Insurance Eligibility

One of the best revenue cycle management practices that is often overlooked is being more strict about verifying patient insurance. Verify insurance before providing treatment to new patients. Have a plan to follow up on pre-authorizations if they are required. Prior authorizations are required for around 99 percent Medicare Advantage plans. It is important that providers check these requirements before providing services. Otherwise, patients may be left with unpaid bills.

Quality Coding and Billing

Deterring unwarranted denials begins with high-quality billing and coding. In-house billing and coders should be constantly retrained and refreshed to keep up with the most recent changes. Consider outsourcing medical claims billing to a company if you are not getting satisfactory results with your in-house medical coders.

In the coming years, it is expected that the outsourced medical claims will grow by more than 11% annually. Outsourced medical billing is more efficient for many providers.

Use AR to manage denials and follow-ups.

Implement a plan to handle claims denials quickly. In healthcare, denials can account for up to 90% of revenue lost. Each denied claim costs an average of $31.50, due to the time spent and costs incurred in revisiting it. Followups on accounts receivable should be a part of the administrative workflow to ensure denials are not left unattended for longer than is necessary.

Maintain Physician Credentialing Processes

Payments from payers can be difficult to collect if an organization’s physicians are not properly credentialed. In 2021, 54 percent of practice claimed that denials were increasing due to provider credentials issues. provider credentials changes are frequent and can be complicated.

Monthly Reporting

Be sure that all financial data is streamlined. Revenue cycle management is more than just keeping a close eye on billing and denials. In addition to addressing denials, a streamlined report must also provide a detailed overview of other aspects of the financial side of your business such as operating costs, billable hours of physicians, etc. Reporting in depth allows practices to analyze financial data, identify loopholes, and spot trends such as revenue growth or loss. To ensure effective communication and prompt updates on financial matters, consider incorporating a bulk email outreach for disseminating important reports and insights to relevant stakeholders within your organization. This not only enhances efficiency but also ensures that key financial information reaches the right recipients in a timely manner.

Establish a clear billing and coding process

Make sure your billing and coding process is well-defined and adheres to industry standards to avoid any potential compliance issues.

CureMD can help your practice improve its healthcare RCM

CureMD’s RCM solutions are tailored to address the challenges that providers face in balancing patient care with profitability. Our RCM solution integrates payment collection with EHR work flow. CureMD’s clients experienced a 45 per cent increase in revenue by using RCM services. These increases are attributed to intelligent, complete claim monitoring as well as a higher acceptance rate for claims the first time.